Our Viewpoint1 argues that expanding access to less effective or more toxic treatments is supported not only by utilitarian ethical reasoning but also by two other ethical frameworks: those that emphasise equality and those that emphasise giving priority to the patients who are worst off. Accordingly, we disagree with the suggestion by Smith and Aloudat that our Viewpoint interprets the issues at stake through a single ethical frame. In any case, however, the principles of beneficence and non-maleficence proposed in their letter would likewise support expanding access to less effective or more toxic treatments.